Context: The caesarean section rate continues to increase in our different health
structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for
primary caesarean sections and to find ways to reduce the increasing rates. Patients
and Method: This is a longitudinal and retrospective study carried out from
June 1, 2018 to July 31, 2022. The study included all patients who had a
cesarean-section for the first time (primary caesarean). An anterior uterine
scar was a non-inclusion criterion. Data were collected prospectively using
Synfonievre and Agopra software via patients’ files and information collection sheet. Data were
analyzed with SPSS 21 software, Mac version. Averages were calculated for
quantitative data and percentages for qualitative data. The statistical tests
used were the Pearson Chi2 test. The observed differences were
considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean
sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main
indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by
the other indications (including preterm delivery, umbilical cord dystocia,
malpresentation of fetus, foetal abnormalities, elective CS, triple gestation,
mother abnormalities); dystocia or prolonged labor (18.7%), breech presentation
in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal
deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led
to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech
presentation during of a twin birth and a singleton. Induction of labor can be
an effective alternative in certain
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